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CHAPTER 11
FUTURE PULL Understanding the Culture in Culture Change by LaVrene Norton
previous encounter with a nursing home where she went to visit her grandmother depressed her. “The big nurses’ station and long hallways with people lined up in chairs, asleep.” With culture change, “I saw an op- portunity to make it better . . . for (those) who had lived a good long life but still has many seasons to go,” she says (Action Pact, 2011).
Conversely, when an organization’s mission is merely to produce profits for shareholders,
There is no forceful purpose, no picture of the future whole, no internal DNA for self-creation or even to provide a reference point for deci- sions. Most of all, the loss of the real and pow- erful natural force of Future Pull occurs when a compelling vision is never created or shared within the organization...Having a purpose al- lows us to be creatively pulled to the future. We are able to build on the past while escaping its bondage! (Land & Jarman, 1992, 177)
THE POTENTIAL FOR POSITIVE IMPACT ON TWO VULNER- ABLE POPULATIONS: THE CONSUMER AND THE CAREGIVER
The life-changing effect it can have on both front- line staff and residents is another reason culture change is particularly powerful in long-term care. Caregivers find opportunities to grow and advance in their careers that are not possible in the institutional model.
Consider Tanya Rhoades, who was very shy when she took her first job as a certified nursing assistant (CNA) 7 years ago. Today she is poised and articulate after advancing first to lead homemaker and certified dietary manager (CDM) and later to household coor- dinator. “I’ve seen myself grow, doing things I thought I would never be able to do, like talk to you,” she tells us.
How did that happen? “When your employer in- vests in you, you give back,” she replies. As a CNA she felt she had leadership potential, but she was too timid to share her opinions or to speak up when she saw something was not right. But in the Household Model, “I’ve learned to open up, connect with, and un- derstand people and have them understand me. There are no barriers now.”
Married with children and having only a high school diploma, she had neither time nor money to
go back to school. When the organization adopted the Household Model, new positions for coordinator and lead homemaker/CDM opened up in each household. In her quest for a position, management paid her tu- ition for a year of correspondence courses and gave her one paid day at work each week to study, during which she and the candidates for the position in the other households joined in a study group on topics such as nutritional management, budgets, and record keeping. They were coached by the nursing home’s nutritionist and other senior staff members. There were workshops to help build communication skills and learning circles common in any Household Model, where “I learned so much about people and their various cultural backgrounds....I came to feel connected to them,” she says. Meanwhile, she applied for and received a house- hold coordinator position with responsibilities similar to those of a nursing home administrator. Her training and her hands-on CNA, lead homemaker, and CDM experience make her a better household coordinator, she says. “You never appreciate another person’s job until you actually have to do it.” And now, after “some- body saw something in me and supported me, I look for those things in others and encourage them,” she says. “I love coming to work. I don’t think too many people can say that,” she concludes (Action Pact, 2011, p. 15).
Residents, too, can continue to grow and realize lifelong dreams. “Ms. Lib” initially dreaded the thought of living in a nursing home. But it was not long after moving into the Household Model that she knew she was in the right place. “I’ve got a beautiful room and lots of friends. . . . I can sit and read all day if I want to,” says the former grammar school teacher. She enjoys reading just about anything, but the Bible is among her favorites. Actually, her lifelong desire was to become a missionary, a fact not lost on Linda Graham, the house- hold life enhancement coordinator. She came to regard Ms. Lib as a close friend and one day asked Ms. Lib to lead a religious devotional on the nursing home patio. “We invited everyone to come out and we had a great crowd,” recalls Ms. Lib. “It was cold as could be so we put blankets around us. . . . We didn’t care, we did the devotional anyway. It went over really big.” Next, Gra- ham urged her to do a devotional for the entire organi- zation in the nursing home “Town Square.” “I worked
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